Narcolepsy is a sleep disorder defined by constant sleepiness and a tendency
to sleep at inappropriate times. Typically, a person with narcolepsy suffers
sleep attacks as well as continual and a feeling of tiredness that is not
relieved by any amount of sleep .If not recognized and appropriately
managed, narcolepsy can drastically and negatively affect the quality of a
person’s life.

Although the exact cause is not known, narcolepsy appears to be a disorder
of the part of the brain that controls sleep and wakefulness. As a result ,
sleep or parts of sleep intrude into the times they are awake. The symptom
most easily understood is the sleepiness, which is just the brain being
unable to control when the individual falls asleep. Other symptoms, such as
cataplexy, hypnagogic hallucinations and sleep paralysis are similar to the
loss of muscle tone or dreaming that accompanies a normal part of sleep
called REM. In people with narcolepsy, these events ( the lack of muscle
tone or the dream experiences) occur at inappropriate times while they are
awake.

Narcolepsy is not caused by psychiatric or psychological problems. Sometimes
narcolepsy runs in families, but many people with narcolepsy do not have
relatives who are affected. Recent studies have found low levels of a brain
chemical called hypocretin in people with narcolepsy. Some researchers have
suggested that a problem with the gene responsible for making hypocretin,
combined with other factors in a person’s in a person’s life, may cause the
disorder.

WHAT ARE THE SYMPTOMS OF NARCOLEPSY?
The four most symptoms of narcolepsy are: excessive daytime sleepiness,
cataplexy, sleep paralysis, and hypnagogic hallucinations. In most causes,
excessive daytime sleepiness is the most bothersome symptom.

Excessive daytime sleepiness— Daytime sleepiness is present in all
narcoleptics and is usually the first symptom that appears. People with
narcolepsy report feeling tired or sleepy all the time . They tend to fall
asleep not only in situations in which many people normally feel sleepy
(after meals or during a dull lecture), but also when most people would
remain awake (while having a conversation , writing a letter, or watching a
movie). These “naps” tend to be short and may be refreshing, at least for a
short period of time. People with narcolepsy may become drowsy or feel foggy
at very unusual times, even in dangerous situations, such as while driving.

Cataplexy— Attacks of cataplexy –sudden, brief losses of muscle strength-
are sometimes the first symptom of narcolepsy, but more often develop months
or years after the onset of sleepiness. Cataplexy can be mild – such as a
brief feeling of weakness in the knees—or it may cause a complete physical
collapse, resulting in a fall. A person having such an attack is fully awake
and knows what is happening . Cataplexy is usually triggered by strong
emotion, such as laughter, anger, or surprise. In some individuals, simply
remembering or anticipating an emotional or anxiety – producing situation
can produce attacks.

Sleep Paralysis— Sleep paralysis is also brief loss of muscle strength, but
occurs when a person is falling asleep or waking up. The person may be
somewhat aware of his or her surroundings, but is unable to move or speak.
Sleep paralysis can be frightening but is not dangerous, since the muscles
that maintain life( the main breathing muscles and the heart) are not
affected.

Hypnagogic Hallucinations— Hypnagogic hallucinations are vivid dreams that
occur when a person is drowsy. The hallucinations may involve disturbing
images or sounds, such as of strange animals or prowlers. These
hallucinations may be frightening because the person has no control over the
events. The dreams can also be upsetting if they are mistaken for
hallucinations caused by mental illness.

OTHER SYMPTOMS OF NARCOLEPSY:
Automatic behaviors are routine tasks performed by a person who is not aware
of doing the activity. Sometimes a person may actually fall asleep and
continue doing an activity, but not remembering it after waking up.
Automatic behaviors can be a symptom of narcolepsy, and can be dangerous if
a person is involved in a potentially hazardous activity, such as driving or
cooking.

Disturbed nighttime sleep- Paradoxically, people with narcolepsy often have
trouble staying asleep at night due
to the brain inability to properly control waking and sleeping. In such
cases, their daytime sleepiness is made worse by the many nighttime
awakenings.

People with narcolepsy also report symptoms of double vision, an inability
to concentrate, memory loss, and headaches. Children with the disorder are
often unable to keep up with their friends or schoolwork, and adults may be
unable to fulfill normal obligations relating to work or family. Depression
may develop due to the social and occupational difficulties. In addition,
other sleep disorders such as sleep apnea and periodic limb movement
disorder occur more frequently in people with narcolepsy.

HOW IS NARCOLEPSY TREATED?
The first step in diagnosing this disorder would be an evaluation by your
healthcare professional to make sur that some other medical illness is not
the cause. The next step is usually a visit to a sleep specialist.

At a sleep disorders center, the specialist would thoroughly review your
medical history and perform a complete physical examination. If the
specialist suspects narcolepsy, you will usually be asked to under go
testing at the sleep center. Two tests, a polysomnogram and a multiple sleep
latency test (MSLT), are commonly performed to confirm the diagnosis of
narcolepsy and determine its severity.

During a polysomnogram, you will spend the night at the sleep center in a
comfortable and private room. Small electrodes placed on your skin record
brain waves, muscle activity, heart rate, and eye movements, while other
devices measure breathing. The procedure is painless and does not involve
needles. This test is needed to determine whether you have other disorders
that may be contributing to your symptoms.

An MSLT is conducted the following day. With the electrodes still in place,
you will be asked to take four or five 20 minute naps at two –hour
intervals. The MSLT monitors how quickly you fall asleep and also your sleep
pattern, since people with narcolepsy frequently have REM ( dreaming ) sleep
even during a brief nap. Consequently, these two test-together with your
symptoms and sometimes a blood test called HLA typing – help the sleep
specialist determine whether your symptoms are caused by narcolepsy or by
another disorder that shares some of its features.

HOW IS NARCOLEPSY TREATED?
Although narcolepsy cannot yet be cured, its symptoms can usually be
controlled or improved so that sufferers experience symptoms less frequently
and lead fairly normal lives. If you are diagnosed with narcolepsy, your
treatment plan will likely have several parts: medication, behavioral
treatment, and management of your environment.

For further information on how to treat narcolepsy, please consult with your
sleep medicine specialist.